Dental Revenue Cycle Specialist

Position Summary The Revenue Cycle Specialist is the front-line steward of the practice's complete billing and collections workflow. This individual manages every financial touchpoint from insurance verification and charge entry through claims submission, payment posting, denial resolution, patient billing, and final account reconciliation. Working in close coordination with the Revenue Cycle Manager and clinical teams, the Specialist plays a critical role in maintaining clean accounts receivable, minimizing claim denials, and ensuring patients receive clear, timely financial communication—all in full compliance with HIPAA and payer guidelines. Essential Duties & Responsibilities Insurance Verification Verify patient insurance eligibility and benefits prior to each appointment via online portals or clearinghouse. Confirm deductibles, annual maximums, coverage percentages, waiting periods, frequency limitations, and missing tooth clauses. Document verification results accurately in the dental software (DSN) and enter estimated patient fees on the appointment screen. Initiate pre-authorizations for major treatment as required by payer. Charge Entry & Coding Review completed treatment against clinical notes to confirm accuracy before billing. Assign correct CDT codes, including modifiers, tooth numbers, surfaces, and quadrant designations. Identify and attach any required narratives; verify the correct fee schedule is applied before submission. Perform 100% review of high-dollar procedure charges prior to claim generation. Claims Submission Generate and submit electronic claim batches daily through the practice clearinghouse. Confirm each claim includes correct subscriber ID, accurate CDT codes, and all required attachments (X-rays, perio charting, narratives). Save submission confirmation reports and reconcile any rejected claims within 24 hours. Maintain target of zero unsubmitted claims older than two business days. Claim Tracking & Follow-Up Run and work the Unpaid Claims Report on a weekly follow-up cycle. Segment outstanding claims by aging bucket (0-14 days: monitor; 15-30 days: follow up; 31+ days: escalate). Contact payers via portal or phone, document reference numbers and call notes, and refile claims when requested. Escalate claims unpaid beyond 45 days to the Revenue Cycle Manager or supervising provider. Denial Management & Appeals Review all EOB denials within 24 hours of receipt and categorize by denial reason (documentation, coding, eligibility, frequency, medical necessity). Correct and resubmit fixable claims promptly; draft and submit formal appeal letters with supporting documentation within payer deadlines. Maintain an up-to-date denial log and contribute to reporting on denial trends. Work toward a practice denial rate below 5%. Payment Posting Post all insurance checks and EFTs on the day of receipt; post patient payments daily. Reconcile EOBs line-by-line, matching allowed amounts, write-off adjustments, insurance payments, and patient responsibility. Flag underpayments for follow-up; ensure all adjustments use standardized codes. Perform weekly reconciliation of deposits versus postings. Patient Billing & Collections Generate patient statements on a weekly or bi-weekly cycle, ensuring insurance has been billed before patient responsibility is communicated. Confirm account balances are accurate and not pending insurance resolution before sending statements. For balances over $250, initiate a patient call within seven days of statement generation. Follow the escalation pathway for aging balances: friendly reminder (30 days), firm follow-up with payment plan offer (60 days), final notice letter (90 days), and referral to collections or write-off review (120 days). Document all billing and collections touchpoints in DSN account notes. Account Reconciliation & Reporting Assist in producing weekly and monthly A/R aging reports for the Revenue Cycle Manager.

Contribute data for KPI tracking:

net collection rate (≥95%), total A/R (<1 month of production), insurance A/R over 60 days (<10%), denial rate (<5%), and clean claim rate (≥90%). Identify discrepancies and take corrective action or escalate as appropriate. Qualifications Education & Experience High school diploma or equivalent required; Associate's degree or certificate in dental/medical billing or healthcare administration preferred. Minimum 1-2 years of experience in dental or medical billing, revenue cycle, or a related financial role in a healthcare setting. Hands-on experience with electronic claim submission and denial management strongly preferred. Technical Skills Proficiency with dental practice management software (Dentrix, Eaglesoft, Open Dental, or similar DSN platforms). Working knowledge of CDT coding, insurance coordination of benefits, and EOB interpretation. Experience using insurance portals and clearinghouses (e.g., Availity, Vyne, Dental Intel). Competency with Microsoft Office (Excel, Word, Outlook); ability to produce and interpret basic reports. Knowledge & Competencies Strong understanding of the full dental revenue cycle from patient eligibility through final payment reconciliation. Working knowledge of HIPAA regulations and patient privacy requirements in billing communications. Familiarity with payer filing deadlines, appeal processes, and documentation standards. Accuracy and attention to detail, particularly in coding, payment posting, and account reconciliation. Effective verbal and written communication skills for patient and payer interactions. Ability to manage a high-volume workload, prioritize aging accounts, and meet daily and weekly deadlines. Collaborative, team-oriented approach with the ability to work independently when needed.

Pay:

From $25.00 per hour

Benefits:

401(k) 401(k) matching Dental insurance Employee discount Flexible schedule Health insurance Health savings account Life insurance Paid time off Retirement plan Vision insurance

Work Location:

In person